Nursing students are continuously exposed to carriers or patients with COVID-19 during the pandemic. The COVID-19 pandemic and its consequences can lead to many emotional reactions in nursing students. The aim of this study was to investigate emotional reactions to COVID-19 and coping strategies in nursing students.
 
 

This descriptive and correlational study was conducted in 2021 at Saveh University of Medical Sciences, Iran, on 106 nursing students chosen by census method. The tools used in this study included two standard questionnaires of emotional reactions to COVID-19 Huang et al. and Carver's coping strategies questionnaire (brief form). Data analysis was performed using SPSS version 19.

The results of this study showed that adverse emotional reactions to COVID-19 disease were high in nursing students, and they experienced a wide range of anxiety, fear, sadness, and anger. The mean score of the dimensions of emotional reactions in anxiety, fear, sadness, and anger, was 4.19, 4.06, 3.08, and 2.89, respectively, which indicates that the level of fear and anxiety was in the high range and the amount of sadness and anger was in the medium range. A study in China by Huang et al., used by nursing students and utilizing a similar questionnaire as in the present study, found that the mean scores were 3.16 for fear, 2.77 for anxiety, 2.84 for sadness, and 2.2 for anger. Compared to the present study, the mean scores were much lower (5). Another study by Cao et al. on students at Changzhi Medical University in China reported that only a small number of students reported moderate anxiety (2.2%) and severe anxiety (0.1%) (15). However, research in China has been conducted in a context where COVID-19 was controlled very early and could be due to the lower negative emotional reactions in the study conducted in China than the current study (5). However, a study by Husky et al. in France on students under house quarantine found that two-thirds of those surveyed developed anxiety (16). In a study with medical students at Hamadan University of Medical Sciences as subjects during the COVID-19 pandemic, it was found that about 28.4% of students were depressed, 17.1% were stressed, 21.8% were anxious, and 20.6% had sleep disorders. (17).
In the present study, it was found that the level of fear and anxiety of female students is higher than male students. Women are thought to be more stressed because they are more emotional (18). Women are significantly more likely than men to suffer from depression, anxiety, and sadness. These findings are regarding gender characteristics. Women pay more attention to their inner experiences and perceptions, their emotions are more fragile and sensitive, and they are more vulnerable to depression, anxiety, and sadness (5). Our study supports this matter. However, in the study of Miri et al., there was no relationship between the genders and the level of anxiety of medical students (17).
There was no statistically significant difference between residence (dormitory and home) and students' emotional reactions. Stress, fear, and other emotional reactions appear to be high in dormitory- and non-dormitory students. However, the type of stress is different. For example, a student living with a family is afraid of contracting the disease to relatives. Other students may have fears and anxieties about intercity traffic or the dormitory's population density issues. In the study of Miri et al., no significant relationship was found between living in a dormitory or a private home with anxiety and stress in medical students (17).
In this study, it was found that the mean scores of problem-based and emotion-based coping strategies were not statistically significant. In other words, students from both classes used coping strategies to the same extent. Previous research has shown that students often use ineffective or negative coping strategies instead of positive coping strategies when faced with stress from health problems (19). Problem-based coping styles have positive consequences on mental health, and emotion-centered coping styles can exacerbate the symptoms of mental illness. Therefore, further development and use of problem-oriented coping styles can be useful in increasing the health and reducing health problems of nursing students. People who use ineffective coping styles facing everyday stress do not reduce stress but increase it (20).
The results showed a significant positive correlation between emotion-based coping strategies and the domains of fear, anxiety, and anger. In other words, as the use of emotion-centered coping strategies increased, the scores of fear, anxiety, and anger increased reciprocally. Of course, given that the present study is a cross-sectional study, it is not possible to claim with certainty about its causal relationship, and there may be a cycle of "more fear-more confrontation and more confrontation-more fear" among students. However, there was no significant relationship between problem-based coping strategies and the dimensions of emotional reactions to COVID-19. In Huang et al.'s study, there was a significant correlation between both coping strategies (problem-based and emotion-based) with fear, anxiety, and anger. In other words, Huang et al.'s research was consistent with the present study in terms of the correlation between emotion-based coping strategies with some dimensions of emotional reactions to COVID-19 but was not consistent with the present study in terms of the relationship between problem-based coping strategy and COVID-19 emotional response dimensions. Emotional reactions to COVID-19 and coping strategies are dependent on contextual and cultural factors, and to some extent, these differences can be justified (5).
Because stress and anxiety are an integral part of life today in the context of COVID-19, everyone must be familiar with the ways and strategies to deal with it. One of the dimensions of crisis intervention is psychological interventions to reduce stress and increase mental health (21).
 
 

 Months after the beginning of the COVID-19 pandemic outbreak, the rate of negative emotional reactions (including fear, anxiety, anger, and sadness) is high in nursing students. There was a positive correlation between emotion-based coping strategies and emotional reactions. Therefore, particular emphasis should be placed on providing psychological support to nursing students as well as teaching coping strategies.
 
 

This project was carried out after obtaining the ethics code in the Saveh School of Veterinary Medicine (IR.SAVEHUMS.REC.1400.007). The authors of this article would like to express their gratitude to the Saveh School of Medical Sciences as well as to the students who participated in this study.
 
 

The authors declared no conflict of interest.